End of Life in the ED – Brain Death and Organ Transplantation

Madison Cohen, Donald Penney

Research output: Contribution to journalArticlepeer-review


Every year thousands of Americans die awaiting an organ transplant. While our knowledge and experience with organ transplantation has only improved, organ availability continues to be a major issue due to a lack of suitable donor organs. A large population of organ donors are those who have been clinically diagnosed as brain dead. Brain death is defined as the irreversible loss of all brain and brainstem functions. Despite brainstem functions being lost, mechanical ventilation and perfusion techniques allow for proper organ maintenance. This gives brain-dead individuals a unique opportunity to serve as multiple organ donors. However, due to mistrust of the organ donation process by the families of brain-dead individuals and a lack of physician comfort with making the diagnosis of brain death less than half of all brain-dead individuals end up serving as organ donors. The purpose of this paper is to provide health care professionals with the currently accepted clinical criteria to determine brain death at the bedside. For each set of diagnostic criteria, we include a discussion of the relevant neuroanatomical pathways of brain stem reflexes and spinal tracts examined. We also include discussions on the importance of the brain-dead patient’s potential role as an organ donor. We hope that this paper can serve as a tool for providers to help those without medical backgrounds understand brain-death. Furthermore, we hope that in doing so we can increase the willingness of brain-dead individuals and their families to act as organ donors.

Original languageAmerican English
JournalThe Journal of Integrated Primary Care
StatePublished - Dec 14 2023

Cite this